The midwifery movement

Jeff Elliott
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Five to seven years expected before practice becomes publicly funded, according to new report

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“Properly regulating this practice will protect mothers and their infants, and ensure that midwives have the appropriate training and qualifications and provide important recognition of this professional group,” said Minister of Health and Community Services Susan Sullivan in a recent press release that delved into issues surrounding a lack of midwifery-based care in the province.

The report, Implementing Midwifery in Newfoundland and Labrador, is meant to help guide the establishment of the practice in the province, beginning with its regulation under the Health Professions Act.

But the announcement, which also acknowledged talks of establishing a transitional College of Midwives, failed to show as much progress as supporters were hoping for, whose pleas began resonating from both the Northern Peninsula and across the province surrounding the impending loss of midwifery services in St. Anthony.

And according to the new report, it will take upwards of five to seven years for midwifery to become publicly funded.

“Establishing midwifery is a long-term investment because it takes policy changes, time and effort to integrate practitioners and a period of time to have sufficient midwives to have an impact on the provision of maternity care,” said Sullivan in the Feb. 27 release.

“We will continue to work with the provincial midwifery body as they form their professional college and provide submissions for the development of regulations.”

 

Spreading the word

Just days after the public were notified of forthcoming changes to the degree with which midwives practice in this province, particularly in St. Anthony, thousands displayed an influx of advocacy.

A Facebook group that garnered nearly 2,500 members in a matter of days and a letter, penned by St. Anthony’s Michelle Dwyer, were such displays.

“In my experience, when services such as these are taken away, they are rarely reinstated,” said Dwyer. “I thought about all the things that midwives did for me, and felt that writing a letter was the least I could do for them to show my appreciation.”

In the letter, Dwyer placed emphasis on the importance of midwifery-based care in the region and the proposed health benefits of the practice. She insisted that the government work to maintain such services.

Dwyer also empathized with women in the area who are expecting, who may not get access to the same type of care that she, and hundreds of others, have acquired and felt the reality presents an injustice.

“Midwives have been caring for women, babies, and families in this area for generations … I saw no legitimate reason why that care should end,” she said, acknowledging an ignited passion that stems from her own experiences of delivering her son with the aid of area midwives.

“They went above and beyond for me, not because they had to but because they genuinely cared for me and for my child … I had their phone numbers and was encouraged to contact them with any ‘first time mom’ questions or concerns, no matter how small they seemed.”

Dwyer pointed to the personable nature of midwives, as one benefit she fears will be lost without a fight for regulation and government acknowledgment of the practice.

“Across Canada, the trend seems to be moving more and more towards women and their partners having a much more active voice in their pre- and post-natal care,” she said. “Women want access to the personal care and advocacy that midwives can provide, and it’s a shame that the Government of Newfoundland and Labrador is dragging its heels on the issue.”

Midwifery-based care may not be for everyone, she said, but “it’s nice to know that all women can make a choice”.

Ultimately, she hopes the continued outpouring of advocacy allows midwifery-based care to remain as it has been in the area for the past century and for this same standard of care to be extended across the province.

“It’s important that women of the area have equal access to the level of care that women have had for generations, and it’s important for midwives to be treated with recognition and respect that they have earned by diligently doing what they do,” she said.

“I’m puzzled that Labrador-Grenfell Health would move to downgrade midwifery services in the area when, in reality, they should be holding up their team-based service as a model of voice and choice to the rest of the province.”

The same rings true with regards to Sylvia Patey’s aspirations.

 

Remembering what was

A retired midwife who moved to St. Anthony in 1995 and who worked within the community for many years, Patey acknowledged the decline of the historically delicate practice.

Midwifery has been a staple in the region for the last 90 years with Dr. Grenfell instigating the movement.

“He came from a country where midwives were the norm – and we’re not talking about lay midwives but professionally trained, qualified and licensed people, in their own country,” she said. “When they came here to work, at the request of Dr. Grenfell, he had to make provisions for them to practice here because there was, and still is, no legislation.”

She acknowledged a historical agreement within the medical profession in this province, as well as the nursing-licensing body – now referred to as the Association of Registered Nurses in Newfoundland and Labrador – that midwives would practice only in Goose Bay and St. Anthony and only deliver babies and care for women within the bounds of the hospital.

Midwifery is currently regulated in nine provinces and territories across Canada and, since her retirement in 2006, Patey has noticed a depletion of the practice in both St. Anthony and Goose Bay, proving the province has managed to fall well behind the pack.

And Patey attributes this downward trend to a lack of recruitment.

“They will not get midwives, particularly, to come to a rural area where they have to work as a nurse and a midwife, but yet get paid less than they would in their own country – eight hours of a shift might be spent as a nurse doing bed baths and giving medications and turning sick patients, and then the last four hours might be spent in the labor room,” she said, acknowledging it’s always been a bone of contention for her that the Health Authority on the Northern Peninsula ‘always had two for the price of one’.

Patey also challenged the stance that, due to a lack of midwifery legislation in the province, there will be insurance issues.

“What happened for the last 90 years?” she questioned. “What happened for the last 30 years that these girls have been there, including myself?”

She recalled a time she was medevac’d to home deliver a baby in William’s Harbour.

“The obstetrician was in the OR at the time, and all I had with me was a pilot team and my experiences,” she said. “An outpost station nurse had come and she was panicking because she had not delivered a baby before. When I got there I delivered the baby, helped the mother and baby get bathed, and brought them back to St. Anthony for a pediatric check.”

At the time, she said, it was understood that the midwifery practice was covered under this aforementioned historical agreement, so it raises questions in her mind as to what the current setback is truly about.

“Is it about power and control, politics, or weaning people off the Northern Peninsula?” she questioned. “If women don’t feel secure now, staying in St. Anthony, relying on General Practitioners (GPs) to come in and deliver their babies, they’re going to move.”

As a result, she said, the younger population in the area will soon diminish.

“And this means the town could eventually die and the hospital could become an outpost clinic,” she said, posing that the government is doing nothing but helping along this plausible reality.

“This is not about insurance, this is about power and control … we’ve got to take this opportunity now by the horns and we’ve got to say ‘enough of this’,” said Patey. “I believe in people power, and I believe women are strong, and I think this is a good time for women in Newfoundland and Labrador, but we need help.

“All the women of NL deserve a choice when it comes to pregnancy and childbirth, but there’s a lot to be done.”

During the mid-to-late nineties Patey was selected to sit on a steering committee in St. John’s with approximately twenty other people, from different parts of the health profession, with a common concern for obstetrics, midwifery and childbirth.

The meeting, she said, took place at the request of the government because a question had been raised about the push for midwifery legislation.

“We sat for nearly two years and formed the bones of the white paper and decided that this needed to be not just a midwifery act but a Health Professions Act,” she said. “There were small groups of health professionals – chiropractors, acupuncturists, and massage therapists – in under that umbrella and the existing midwives would be grandfathered into that regulation and new midwives coming in would have to fit a certain criteria.”

She said the government accepted the Act initially and were quite excited about it but, lo and behold, there was a change of government a few months later and the entire endeavor was shelved.

The Act wasn’t passed until 2010.

But while the other small groups have since been regulated, midwifery still has not and this forms the backbone of recent concerns.

“We want to know why,” said Patey. “There’s lots of work to be done, not only in St. Anthony, but beyond, and women are passionate about it but they need help to get that message out.

“We need people who can spread the word, get people excited about it, get people seeking information about it, lobbying MPs, sending tweets and emails and truly pushing. This is a women’s rights issue … this is a human rights issue.”

Ultimately, she said, she’d like to see women having a choice involving midwifery-led care.

“If people take time to look at the research out there, both current and historical, it quotes that such care is safer than any other model when it comes to ‘normal’ pregnancy and childbirth … it’s what midwives are specialists in,” she said.

“Doctors want women delivered in a timely fashion … they’re interfering with what is a normal physiological process because they want to rush it, rush it, rush it,” she said. “In St. Anthony, with no midwife input, you will see higher intervention rates with more women being induced before their time, a higher rate of episiotomies, higher caesarian section and assisted birth rates and there will eventually be higher postpartum hemorrhages.”

When midwives give care, she emphasized, they give it from the beginning of the pregnancy to the end of the delivery, and then into the postpartum period.

“There’s a consistency of care but, now, the woman will see an obstetrician, a GP following her up, an obstetric nurse laboring her, a GP doing the delivery before being passed back again to the obstetric nurse and onto public health,” she said. “She will not know whether she’s coming or going, and she won’t look back on it as a special experience in her life and for some people it only happens once.”

 

Making the difference

For Dawn Alcock, the experience happened three times, but only one of her children was delivered with the help of a midwife.

Having given birth to her first two children – Grace, 7, and Reid, 4 – in St. John’s, she said there’s a striking difference between the two settings, with regard to the care she received during the delivery process.

“In a bigger city, like St. John’s, where midwifery is not available, you’re hospitalized and everything is very medical – you’re just a person having a baby and, basically, another number,” she said. “Regardless of what complication you run into, and the kind of birth you have, it doesn’t matter to them … it’s very impersonal.”

During her first delivery, under the care of a GP, Alcock experienced a 28-hour labor and pushed through a four-hour-long crowning. A specialist needed to be called in after the baby went into distress from the length of the ordeal, and forceps needed to be used to aid in the delivery.

“It was very traumatizing, and when [Grace] was born she was lifeless,” said Alcock, acknowledging that the institution lacked a ‘personal touch’.

Her first experience with a midwife, once relocating to St. Anthony from St. John’s, was also quite traumatic after experiencing a miscarriage, but she explained the breadth of care she received was paramount.

“It was a very devastating thing to have to deal with and, psychologically, it’s very difficult,” she said. “I was blown away by the degree of their care; of them coming to my room and sitting down and talking to me, and just being available to help me work through all of the emotions.”

Birth is largely psychological for a woman, said Alcock, and midwives provide that type of support, to coincide with the emotional.

Though she doesn’t wish to detract from GPs and OB-GYNs, she said physicians don’t provide that same level of care.

And Alcock said it’s the personal care, their compassion, their understanding and their gentleness that sets them apart.

“In my opinion, midwives are the frontline runners and they’re the ones who should be delivering babies,” she said, declaring that having her baby in St. Anthony was a more ‘beautiful’ experience.

After delivering her third child, Bria, 1, the midwives placed the newborn on Alcock’s chest right away, with umbilical cord still attached – a moment she didn’t experience after the births of her other children.

The midwife also bathed her.

“I can’t explain to you the level of personal care,” she said. “It’s very nurturing and supportive and it’s what women need.”

She said that within three weeks she was over the delivery, with a healed body.

“It was such a natural experience because they know what they’re doing,” said Alcock.  “You’d almost want to have a dozen [children], just to have that experience.”

She said it is her hope that the government comes to their senses and realizes that as women, and mothers and mothers-to-be, they should have the choice of how their babies are delivered.

While the newly announced guide, created by two consultants from McMaster University and submitted to the Provincial Government in December 2013, is certainly a step forward, it appears publicly funded midwifery isn’t within arms reach quite yet.

 

Organizations: College of Midwives, Community Services Susan Sullivan, Labrador-Grenfell Health Association of Registered Nurses Health Authority on the Northern Peninsula McMaster University

Geographic location: St. Anthony, Newfoundland and Labrador, Northern Peninsula Canada Goose Bay

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